Association between centralization and directional preference and functional and pain outcomes in patients with neck pain.

Study Design: Retrospective cohort.

Objectives: In subjects with neck pain, the present study aimed (1) to describe the prevalence of centralization (CEN), noncentralization (non-CEN), directional preference (DP), and no directional preference (no DP); (2) to determine if age, sex, fear-avoidance beliefs about physical activity, number of comorbid conditions, or symptom duration varies among subjects who demonstrate CEN versus non-CEN and DP versus no DP; and (3) to determine if CEN and/or DP are associated with changes in function and pain.

Background: CEN and DP are prevalent among patients with low back pain and should be considered when determining treatment strategies and predicting outcomes; however, these findings are not well investigated in patients with neck pain.

McKenzie lumbar classification: inter-rater agreement by physical therapists with different levels of formal McKenzie postgraduate training.

Study Design: Inter-rater chance-corrected agreement study.

Objective: The aim was to examine the association between therapists' level of formal precredential McKenzie postgraduate training and agreement on the following McKenzie classification variables for patients with low back pain: main McKenzie syndromes, presence of lateral shift, derangement reducibility, directional preference, and centralization.

Summary Of Background Data: Minimal level of McKenzie postgraduate training needed to achieve acceptable agreement of McKenzie classification system is unknown.

Psychometric properties and practicability of the self-report urinary incontinence questionnaire in patients with pelvic-floor dysfunction seeking outpatient rehabilitation.

Background: Pelvic-floor dysfunction (PFD) affects a substantial proportion of individuals, mostly women. In responding to the demands in measuring PFD outcomes in outpatient rehabilitation, the Urinary Incontinence Questionnaire (UIQ) was developed by FOTO in collaboration with an experienced physical therapist who has a specialty in treating patients with PFD.

Objective: The purpose of this study was to evaluate psychometric properties and practicability of the 21-item UIQ in patients seeking outpatient physical therapy services due to PFD.

Clinician's ability to identify neck and low back interventions: an inter-rater chance-corrected agreement pilot study.

Objective: To estimate inter-rater agreement of physical therapists trained in MDT approach and participating in practice-based evidence (PBE) research to identify 72 physical therapy interventions in video demonstrations on a single model and clinical vignettes. PBE is a well designed observational study and demonstrating clinician observational consistency is an important step in conducting PBE research design.

Methods: Two physical therapists volunteered to participate in pilot reliability testing and seven other physical therapists trained in McKenzie Mechanical Diagnosis and Therapy (MDT) methods volunteered for the inter-rater chance-corrected agreement study.

Influence of fear-avoidance beliefs on functional status outcomes for people with musculoskeletal conditions of the shoulder.

Background: The influence of elevated fear-avoidance beliefs on change in functional status is unclear.

Objective: The purpose of this study was to determine the influence of fear-avoidance on recovery of functional status during rehabilitation for people with shoulder impairments.

Design: A retrospective longitudinal cohort study was conducted.

Characteristics of patients seeking outpatient rehabilitation for pelvic-floor dysfunction.

Background: Pelvic-floor dysfunction (PFD) affects a substantial proportion of individuals, especially women.

Objective: The purposes of this study were: (1) to describe the characteristics of individuals with disorders associated with PFD who were seeking outpatient physical therapy services and (2) to identify the prevalence of specific pelvic-floor disorders in the group.

Design: This was a prospective, longitudinal, cohort study of 2,452 patients (mean age=50 years, SD=16, range=18-91) being treated in 109 outpatient physical therapy clinics in 26 states (United States) for their PFD.

Lumbar computerized adaptive test and Modified Oswestry Low Back Pain Disability Questionnaire: relative validity and important change.

Study Design: Retrospective analysis of longitudinal, observational cohort data.

Objectives: To compare discriminating ability and minimal clinically important improvement (MCII) calculated using functional status (FS) measures estimated from the lumbar computerized adaptive test (LCAT) and Modified Oswestry Low Back Pain Disability Questionnaire (ODQ).

Background: The LCAT and ODQ are commonly used to estimate FS in patients seeking outpatient therapy but have not been compared directly.

Referral source and outcomes of physical therapy care in patients with low back pain.

Study Design: Retrospective longitudinal cohort.

Objectives: To describe the clinical characteristics of patients with low back pain according to physician referral source, and to identify associations between referral source and discharge functional status, as well as number of physical therapy visits.

Background: Little is known about associations between physician referral source and outcomes of physical therapy care for patients with low back pain.

Change in psychosocial distress associated with pain and functional status outcomes in patients with lumbar impairments referred to physical therapy services.

Study Design: Prospective, longitudinal, observational cohort design.

Objective: The primary aim was to examine the association between changes in psychosocial distress (PD), and functional status (FS) and pain intensity at discharge from physical therapy.

Background: Patients with lumbar impairments seeking physical therapy commonly demonstrate elevated PD.

Using intake and change in multiple psychosocial measures to predict functional status outcomes in people with lumbar spine syndromes: a preliminary analysis.

Background: Managing patients with lumbar spine syndromes who are seeking outpatient physical therapy represents a complex problem where psychosocial constructs such as fear-avoidance beliefs regarding physical activities or work activities, somatization, and depressive symptoms may affect functional status (FS) outcomes.

Objective: The purpose of this study was to determine whether intake or changes in fear-avoidance beliefs regarding physical or work activities, somatization, and depressive symptoms assessed simultaneously affect FS outcomes prediction.

Design: This study was a secondary analysis of prospectively collected, longitudinal, observational cohort data.

Total number and severity of comorbidities do not differ based on anatomical region of musculoskeletal pain.

Study Design: Secondary analysis, cross-sectional study.

Objectives: To (1) compare differences in individual comorbidity rates among patients with cervical, lumbar, and extremity pain complaints and (2) compare rates based on total number and severity in these same patient groups.

Background: Comorbidities can impact recovery, prognosis, and potentially hinder participation in rehabilitation.

Single-item screens identified patients with elevated levels of depressive and somatization symptoms in outpatient physical therapy.

Objective: Develop efficient and accurate screening tools to identify elevated levels of depressive or somatization symptoms, which can adversely affect functional status outcomes.

Methods: We conducted a secondary analysis of prospectively collected depressive and somatization symptoms (Symptom Checklist 90-Revised) data from 10,920 patients receiving outpatient physical therapy for a variety of neuromusculoskeletal diagnoses. Item response theory methods were used to analyze data, with particular emphasis on differential item functioning among groups of patients, and to identify potential screening items.

Construct validation of a knee-specific functional status measure: a comparative study between the United States and Israel.

Background: Comparative effectiveness research (CER) requires valid outcome measures that discriminate patients by risk factors in similar ways across settings. Standardized functional status (FS) measures in physical therapy are used routinely in multiple countries, creating the potential for CER among countries.

Objective: The purpose of this study was to assess known-groups construct validity of a knee-specific FS measure within and between 2 countries for patients receiving outpatient physical therapy due to knee impairments.

Effect of fear-avoidance beliefs of physical activities on a model that predicts risk-adjusted functional status outcomes in patients treated for a lumbar spine dysfunction.

Study Design: Retrospective analysis of a prospective, longitudinal cohort study of 30 858 patients being treated for a lumbar spine dysfunction in outpatient physical therapy.

Objectives: To determine effect of adding a single-item screening variable classifying patients with elevated versus not-elevated scores of fear-avoidance beliefs of physical activities at intake, on a model predicting risk-adjusted functional status (FS) outcomes.

Background: Outcomes must be risk-adjusted before making meaningful interpretations.

Baseline dependency of minimal clinically important improvement.

Background: Minimal clinically important improvement (MCII) is the smallest outcome measure change important to patients. Research suggests that MCII is dependent on patients' baseline functional status measures.

Objective: The purposes of this study were: (1) to confirm whether MCII is dependent on patients' admission scores and (2) to test whether MCII is dependent on selected demographic characteristics.

Depressive symptoms, anatomical region, and clinical outcomes for patients seeking outpatient physical therapy for musculoskeletal pain.

Background: Clinical guidelines advocate the routine identification of depressive symptoms for patients with pain in the lumbar or cervical spine, but not for other anatomical regions.

Objective: The purpose of this study was to investigate the prevalence and impact of depressive symptoms for patients with musculoskeletal pain across different anatomical regions. Design This was a prospective, associational study.

Developing a wellness program for people with multiple sclerosis: description and initial results.

Because multiple sclerosis (MS) is a multidimensional chronic disease, effective management of the illness requires a multidimensional approach. We describe a wellness program that was designed to facilitate positive health choices throughout the course of MS and present initial data analyses. We hypothesized that over the course of the program, participants would demonstrate improvement in the domains assessed.

Association between centralization, depression, somatization, and disability among patients with nonspecific low back pain.

Study Design: Secondary analysis of a prospective observational cohort study.

Objectives: To evaluate whether depression and somatization subscores of the Symptom Checklist-90-Revised (SCL-90-R), which have been shown to identify chronic disability in individuals with nonspecific low back pain, are applicable to a different population of individuals with low back pain; and to determine if this potential association is confounded by a combination of centralization and subsequent treatment based on centralization.

Background: To help direct management of patients with nonspecific low back pain, recommendations include performing tests designed to identify psychosocial risk factors predictive of poor patient outcomes.

Association between directional preference and centralization in patients with low back pain.

Study Design: Prospective, longitudinal, observational cohort.

Objectives: Primary aims were to determine (1) baseline prevalence of directional preference (DP) or no directional preference (no-DP) observed for patients with low back pain whose symptoms centralized (CEN), did not centralize (non-CEN), or could not be classified (NC), and (2) to determine if classifying patients at intake by DP or no-DP combined with CEN, non-CEN, or NC predicted functional status and pain intensity at discharge from rehabilitation.

Background: Although evidence suggests that patient response classification criteria DP or CEN improve outcomes, previous studies did not delineate relations between DP and CEN findings and outcomes.

Cross-cultural differences in knee functional status outcomes in a polyglot society represented true disparities not biased by differential item functioning.

Background: Comparative effectiveness research across cultures requires unbiased measures that accurately detect clinical differences between patient groups.

Objective: The purpose of this study was to assess the presence and impact of differential item functioning (DIF) in knee functional status (FS) items administered using computerized adaptive testing (CAT) as a possible cause for observed differences in outcomes between 2 cultural patient groups in a polyglot society.

Design: This study was a secondary analysis of prospectively collected data.

Implementing computerized adaptive tests in routine clinical practice: experience implementing CATs.

This paper traces the development, testing and use of CATs in outpatient rehabilitation from the perspective of one proprietary international medical rehabilitation database management company, Focus On Therapeutic Outcomes, Inc. (FOTO). Between the FOTO data in the United States and Maccabi Healthcare Services data in Israel, over 1.

Translating shoulder computerized adaptive testing generated outcome measures into clinical practice.

Study Design: Prospective longitudinal cohort study.

Introduction: Increased use of computerized adaptive tests (CATs) to generate outcome measures during rehabilitation has stimulated questions concerning score interpretation.

Purpose Of The Study: The purpose of the study was to describe meaningful interpretations of scores from patient self-report shoulder functional status (FS) outcome measures estimated using a shoulder CAT (score range=0-100).

Weighted index explained more variance in physical function than an additively scored functional comorbidity scale.

Objective: 1) examine association between the Functional Comorbidity Index (FCI) and discharge functional status (FS); 2) examine impact of FCI on FS when added to comprehensive models; and 3) compare additive FCI with weighted FCI and list of condition variables (list).

Study Design And Setting: Patients were drawn from Focus On Therapeutic Outcomes, Inc. (FOTO) database (1/1/06-12/31/07).

Clinical interpretation of outcome measures generated from a lumbar computerized adaptive test.

Background: A computerized adaptive test (CAT) provides a way of efficiently estimating functional status in people with specific impairments.

Objective: The purpose of this study was to describe meaningful interpretations of functional status (FS) estimated using a lumbar CAT developed using items from the Back Pain Functional Scale (BPFS) and selected physical functioning items. Design and Setting This was a prospective longitudinal cohort study of 17,439 patients with lumbar spine impairments in 377 outpatient rehabilitation clinics in 30 states.